title: To Mohs or not to Mohs.
abstract: BACKGROUND
  The preferred method of treatment of Dermatofibrosarcoma Protuberance (DFSP) is surgery. Clear margins are achieved by wide local excision (WLE) or by Mohs micrographic surgery. Mohs surgery and reconstruction always requires two or more procedures. This study aims to assess the ability of WLE to accomplish clear histopathological margins and low recurrence rate with a single procedure. We present our results from ten years experience of wide local excision.
  
  
  METHODS
  This is a retrospective analysis of data of all cases of DFSP treated with WLE by a single operator in our department between 2002 and 2012.
  
  
  RESULTS
  Twenty patients were identified. The surgical excision and reconstruction were performed on the same day in all cases. The mean histological peripheral margin was 17 mm and the deep 9 mm. There was no incomplete excision and no recurrence recorded. There were no postoperative complications or tumour recurrences reported for an average period of 5.6 years follow-up.
  
  
  CONCLUSIONS
  Mohs surgery offers clear histological margins but requires multiple patient visits to achieve complete excision and later reconstruction. We show that WLE can achieve these in one procedure, the excision margins making little difference when planning the eventual reconstruction.
authors.affiliation: Plastic and Reconstructive Surgery Department, St George's Hospital, Tooting, London, UK. Electronic address: konkok@btinternet.com.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Kokkinos
authors.affiliation: Plastic and Reconstructive Surgery Department, St George's Hospital, Tooting, London, UK.
authors.forename: Tracy
authors.initials: T
authors.lastname: Sorkin
authors.affiliation: Plastic and Reconstructive Surgery Department, St George's Hospital, Tooting, London, UK.
authors.forename: Barry
authors.initials: B
authors.lastname: Powell
mesh_terms: D000328:Adult; D000368:Aged; D018223:Dermatofibrosarcoma / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018365:Neoplasm, Residual; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps; D055815:Young Adult
keywords: Dermato-oncology; Dermatofibrosarcoma protuberance; Mohs surgery; Plastic surgery; Wide local excision